Provider Demographics
NPI:1114348117
Name:AWARENESS COUNSELING CENTER
Entity type:Organization
Organization Name:AWARENESS COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:386-774-1330
Mailing Address - Street 1:2425 S VOLUSIA AVE
Mailing Address - Street 2:SUITE B-4
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7625
Mailing Address - Country:US
Mailing Address - Phone:386-774-1330
Mailing Address - Fax:888-808-2088
Practice Address - Street 1:2425 S VOLUSIA AVE
Practice Address - Street 2:SUITE B-4
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7625
Practice Address - Country:US
Practice Address - Phone:386-774-1330
Practice Address - Fax:888-808-2088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW42601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL764134600Medicaid
FL764134600Medicaid